Customer Information Form

Customer Contact Information Form

Thank you for the opportunity to help you plan your next vacation! The more information I have from you, the better I am able to create a personalized itinerary that best suits your needs. Please complete this form as thoroughly as possible, and please allow me 1-2 days to find you some options. In the meantime, feel free to contact me at (678) 485-4760 or email me at srogerstaylor@gmail.com should you have any additional questions.

* I charge a research fee for my travel planning research:

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$25 for individuals or groups with up

to 8 ppl

$50 for Groups of 8+ to 15 pp''''''''''''''l

$100 for Groups with 15+ or' ?more ppl
Personal Info #1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
E-mail
example@example.com
YesNoIn process
Guest #2

First NameLast Name
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
YesNoIn process
Any additional travelers? Adults? Children? Please include names and ages with D.O.B below.
Where would you like to travel? Include any specific details.
What is your city of departure?
Preferred Departure Date?

MonthDayYear
Preferred Return Date?

MonthDayYear
What is your budget for this trip (per person)? **Please enter a dollar amount.***
FlightsHotel / ResortCar RentalOcean CruiseRiver CruiseTours / Excursions / ActivitiesAirport TransfersOther - please note below
Type a question or request
5 star4 star3 star
Is there a specific hotel brand you prefer? Is so, please note below.
YesNoIt does not matter
Please provide any additional info you'd like me to know.
EmailPhone
Documentation You are required to have documentation to leave the United States. It is your responsibility to have the proper paperwork to enter a country. Passports must be valid for 6 months beyond the completion date of your travel. If you are not a United States citizen please inform your Travel Advisor at time of booking. You can still book your vacation while in process of getting your passport. Please inform your agent of any other concerns.
Sign Up for our Weekly Travel Newsletter!
example@example.com
Research Fee*
prevnext( X )
Research Fee$25.00
For Individuals and a Group up tp 4 ppl. Includes up to 2 locations

Research Fee
Item subtotal:$0.00

Total $0.00
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Taylor'd Destinations (678) 485-4760 srogerstaylor@gmail.com shuntelrogerstaylor.inteletravel.com
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